Disaster Preparedness: Laboratory Table Top Exercise

Suzanne H. Butch, MA, MLS(ASCP)CM

Clinical Pathology Quality Assurance

University of Michigan Hospitals and Health Centers

Department of Pathology, Division of Quality and Healthcare Improvement

Lab to FMEA

FMEAFMEA

Your Lab

Disaster Preparedness

• Involves each lab, facility, local, area, state, regional and national resources

•Defined structure for communicating needs

• Stockpiles of supplies

•Mobile response system

Exercises

• Required to participate in an exercise by accrediting agencies

• Recent national exercises • Earthquake • Cyber • Chemical • Terrorist

• Local focus • Active shooter • Nuclear plant • Biohazard • Chemical hazard

Continuum of Exercises

• More Experience

• Greater Complexity

• More Preparation Time

• Increased Cost

Table Top

Full Scale/ Comprehensive

Plan and Review

Photo US Coast Guard, Missouri 2008

Table Top Exercise

•Review of the processes and procedures that would be used in a real disaster

•Used to detect issues that may interfere with conducting a realistic simulation

Walk Through Exercise

• Shift from paper based to hands-on

•Physical actions are required

•Determine if procedures in a plan will work

Modular/Component Exercise • Focuses on a single critical business

function • Call tree

• Computer server

Functional/Line of Business

• Exercise based on purpose of work

• Example: Command Center Exercise

Simulation/Mock Exercise

• Simulates a disaster

• Exercises the response and recovery roles

•Realistic

Photo: MTA New York City Transit / Marc A. Herman

Comprehensive

• Extensive and complex exercise

• Engages many parts of the organization

•Re-enact the worst case scenario

Timing

• Scheduled

• Surprise

What is a Table Top Exercise?

•Definition: • A planned exercise where decision making

individuals react to a sequence of events related to a themed incident

• No pretend or real patients are involved

Why Do a Table Top Exercise? • Tests the interactions and

communications of individuals and groups

•Practices decision making

•Aids in identifying weaknesses and co-dependencies

•Provides practice for all involved

Key Factors

•Develop exercise

•Participant selection

• Scenario development

Exercise Purpose

•Provide participants with an opportunity to evaluate current response concepts, plans, and capabilities for a specific incident

•Discuss roles, responsibilities and anticipated activities – plans, policies and procedures

Who Participates?

•Decision making individuals

•A representative of all the groups that would be involved in the event

Laboratory Involvement

•Often overlooked by planners

• It is more than specimen collection

•Patient identification is critical

•What changes in lab testing need to be made to support the disaster scenario?

Selecting a Topic

• Involvement • Involves only lab

• Involves other areas of the institution

• Outside the institution

•Relevant to location

My Location

• Snow/ice storm

•President giving graduation speech in Michigan Stadium

•100,000 (extra) people • Hockey games on New Years Day in Michigan

Stadium

• Ann Arbor Art Fair on hot July day

• Football Saturdays

Photo by Michael Barera Michigan Stadium 2010

Incidents from Elsewhere

•Boston Marathon

•Paris terrorism

•US shootings

• Earthquakes

•Hurricanes

• Tornadoes

• Snow, more snow, and even more snow

Exercise Plan Development

•Use a committee to write the exercise

•Not the same people who wrote the plans for disaster response

•Don’t make it too big or complicated

•Disaster not a doomsday scenario

• It is about team building and relationships

Participants

•No more than 15

•Right participants – decision making

• Train participants • Plan

• Process

• Roles

Creating the Exercise

• Scenario setting – critical business function

•Consider what is going to be done and not done

• Take people out of their comfort zone

•Create the sequence of events

Creating the Exercise

• End with a positive outcome in the scenario

• Support for recording participant reactions

•Debrief

Activation

•Where does it start • Overhead announcement

• Telephone tree

• Paging

What Is Our First Response?

•What’s up?

•But- it is much more than communication

Let’s Practice

•Volunteers Needed • Laboratory Director

• Laboratory Supervisor

• Technologist

• Security Representative

• Maintenance Representative

• Computer Services Representative

• Observers

Scenario

• It is 3:00 pm in the afternoon in August in the Midwest.

•Power goes out – 3 seconds later emergency power sources come alive

What are our questions?

• What is happening?

• How do I get updates?

• What is my current situation? • People – and skill sets

• Equipment & utilities

• Supplies

• What should I do to support the event?

• How long will this last?